MedicaidPrior AuthMedium impact
Rystiggo (rozanolixizumab-noli) (New)
Humana·IN · Neurology, Allergy & Immunology·Medicaid
Effective date
Aug 1, 2026
We identified it
Aug 4, 2026
Summary
Humana Medicaid Indiana has established a new prior authorization policy for Rystiggo (rozanolixizumab-noli), effective August 1, 2026. This monoclonal antibody is covered for generalized myasthenia gravis (gMG) patients who are anti-AChR or anti-MuSK antibody positive and have failed or cannot tolerate pyridostigmine and at least one immunosuppressive therapy. All prescriptions require prior authorization, confirmation of antibody status, specialist oversight, and documented prior treatment attempts.
Action Required
By August 1, 2026: Billing team must establish prior authorization workflow for Rystiggo (rozanolixizumab-noli) claims for Humana Medicaid Indiana members. (1) Update billing system to flag all Rystiggo subcutaneous solution prescriptions for prior auth verification. (2) Create internal checklist requiring providers to submit: confirmed gMG diagnosis, anti-AChR or anti-MuSK antibody test results, treating neurologist name/credentials, documentation of prior pyridostigmine use, AND documentation of prior trial or contraindication to at least one immunosuppressive agent (azathioprine, cyclosporine, mycophenolate mofetil, tacrolimus, methotrexate, cyclophosphamide, or cyclosporine). (3) Notify prescribing neurologists of the new authorization requirement and required supporting documentation. (4) Update claim submission templates to collect antibody type (AChR vs. MuSK) at point of service. Claims submitted without completed prior authorization will be denied. Note: Policy specifies plan year initial and renewal durations but does not state specific approval lengths; contact Humana PAL for claim code requirements via www.humana.com/PAL.